Mililani Chess Club

Member Information Form

DATE:  ________________________Birth date:  ________________________

Player's Last Name:  ______________________First Name: _______________________MI: ____

Parent's Name(s):   ______________________________________________

(If player is under 18 years old)

Address:  ____________________________ City:  ___________________ Zip Code:  ___________

Home phone:  __________________

E-mail address:  _____________________________ (This is the best way to keep up to date.  There are many free e-mail service providers available.)

School:  ___________________________Grade:  ________

USCF Number: ____________________Expiration date: ________USCF Rating:  __________

Chess equipment owned:

  ____Tournament grade set ____Chess Clock____Chess software/computer

How did you find out about our club?  _____________________________________________________________

If not a rated player, circle your estimate of your skill level:

BeginnerAverageGood

(You think you know(You know what castling and en passant are.)(You have suggestions for

how the horsey moves.) Kasparov against Deep Blue)

Check the chess activities that most interest you:

TournamentsLessonsCasual GamesGroup Travel

Quick/Speed/Blitz ChessTeamsChess variations

(Give-away, kriegspiel, bughouse, etc.)

Other (list, i.e.teaching, help club setup, help at tournaments, refreshments, etc.):

Suggested Annual Club dues:Adult ($24/year or $2 / month remaining) _______

(Annual Membership dates:  1 July to 30 June)    (Entitles you to vote on club issues)

    Youth ($12/year or $1 / month remaining) _______

    (Under 21 years old)

    Family ($48/year or $4 / month remaining) _______

   (Entitles family to two adult voting members & all children)

TOTAL Dues:  _____________

Donations:  $ ____________ (We are an IRS-recognized 501(c)(3) non-profit organization.  Your donations are tax deductible.  Receipt will be provided.)